Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children
Background: Extrahepatic portal venous obstruction (EHPVO) is the most common cause of pediatric portal hypertension. We analyzed the investigative protocol and results of portosystemic shunts in this group of patients. Materials and Methods: A total of 40 consecutive children aged below 12 years op...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2014-01-01
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| Series: | Journal of Indian Association of Pediatric Surgeons |
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| Online Access: | http://www.jiaps.com/article.asp?issn=0971-9261;year=2014;volume=19;issue=2;spage=80;epage=84;aulast=Sharma |
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| author | Nitin Sharma Minu Bajpai Arbinder Kumar Shashi Paul Manisha Jana |
| author_facet | Nitin Sharma Minu Bajpai Arbinder Kumar Shashi Paul Manisha Jana |
| author_sort | Nitin Sharma |
| collection | DOAJ |
| description | Background: Extrahepatic portal venous obstruction (EHPVO) is the most common cause of pediatric portal hypertension. We analyzed the investigative protocol and results of portosystemic shunts in this group of patients. Materials and Methods: A total of 40 consecutive children aged below 12 years operated with a diagnosis of extra-hepatic portal hypertension formed the study group. Historical data and clinical data were collected. All patients underwent upper gastrointestinal endoscopy, ultrasound Doppler and computed tomographic portogram pre-operatively and post-operatively. Results with respect to shunt patency, hypersplenism and efficacy of different radiological investigations were collected. Results: A total of 40 patients, 28 boys and 12 girls constituted the study group. Lienorenal shunt (LRS) was performed in 14 patients; distal splenorenal shunt in 21 patients and side-to-side lienorenal shunt in 4 patients, inferior mesenteric renal shunt was performed in 1 patient. Follow-up ranged from 36 to 70 months. At a minimum follow-up of 3 years, 32 (80%) patients were found to have patent shunts. Patent shunts could be visualized in 30/32 patients with computer tomographic portogram (CTP) and 28/32 with ultrasound. Varices regressed completely in 26/32 patients and in the rest incomplete regression was seen. Spleen completely regressed in 19/25 patients. Hypersplenism resolved in all patients with patent shunts. Conclusions: Portosystemic shunting in children with EHPVO is a viable option. While long-term cure rates are comparable with sclerotherapy, repeated hospital visits are reduced with one time surgery. Pre-operative and post-operative assessment can be performed with complimentary use of ultrasound, CTP and endoscopy. |
| first_indexed | 2024-12-13T18:07:51Z |
| format | Article |
| id | doaj.art-b1ba39d7e68746dcac3463d65ffd4453 |
| institution | Directory Open Access Journal |
| issn | 0971-9261 1998-3891 |
| language | English |
| last_indexed | 2024-12-13T18:07:51Z |
| publishDate | 2014-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Indian Association of Pediatric Surgeons |
| spelling | doaj.art-b1ba39d7e68746dcac3463d65ffd44532022-12-21T23:36:02ZengWolters Kluwer Medknow PublicationsJournal of Indian Association of Pediatric Surgeons0971-92611998-38912014-01-01192808410.4103/0971-9261.129599Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in childrenNitin SharmaMinu BajpaiArbinder KumarShashi PaulManisha JanaBackground: Extrahepatic portal venous obstruction (EHPVO) is the most common cause of pediatric portal hypertension. We analyzed the investigative protocol and results of portosystemic shunts in this group of patients. Materials and Methods: A total of 40 consecutive children aged below 12 years operated with a diagnosis of extra-hepatic portal hypertension formed the study group. Historical data and clinical data were collected. All patients underwent upper gastrointestinal endoscopy, ultrasound Doppler and computed tomographic portogram pre-operatively and post-operatively. Results with respect to shunt patency, hypersplenism and efficacy of different radiological investigations were collected. Results: A total of 40 patients, 28 boys and 12 girls constituted the study group. Lienorenal shunt (LRS) was performed in 14 patients; distal splenorenal shunt in 21 patients and side-to-side lienorenal shunt in 4 patients, inferior mesenteric renal shunt was performed in 1 patient. Follow-up ranged from 36 to 70 months. At a minimum follow-up of 3 years, 32 (80%) patients were found to have patent shunts. Patent shunts could be visualized in 30/32 patients with computer tomographic portogram (CTP) and 28/32 with ultrasound. Varices regressed completely in 26/32 patients and in the rest incomplete regression was seen. Spleen completely regressed in 19/25 patients. Hypersplenism resolved in all patients with patent shunts. Conclusions: Portosystemic shunting in children with EHPVO is a viable option. While long-term cure rates are comparable with sclerotherapy, repeated hospital visits are reduced with one time surgery. Pre-operative and post-operative assessment can be performed with complimentary use of ultrasound, CTP and endoscopy.http://www.jiaps.com/article.asp?issn=0971-9261;year=2014;volume=19;issue=2;spage=80;epage=84;aulast=SharmaComputer tomographic portogramdistal spleno-renal shuntendoscopic sclerotherapyextra-hepatic portal hypertensionextra-hepatic portal venous obstructionhypersplenismlieno-renal shunt |
| spellingShingle | Nitin Sharma Minu Bajpai Arbinder Kumar Shashi Paul Manisha Jana Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children Journal of Indian Association of Pediatric Surgeons Computer tomographic portogram distal spleno-renal shunt endoscopic sclerotherapy extra-hepatic portal hypertension extra-hepatic portal venous obstruction hypersplenism lieno-renal shunt |
| title | Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children |
| title_full | Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children |
| title_fullStr | Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children |
| title_full_unstemmed | Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children |
| title_short | Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children |
| title_sort | portal hypertension a critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children |
| topic | Computer tomographic portogram distal spleno-renal shunt endoscopic sclerotherapy extra-hepatic portal hypertension extra-hepatic portal venous obstruction hypersplenism lieno-renal shunt |
| url | http://www.jiaps.com/article.asp?issn=0971-9261;year=2014;volume=19;issue=2;spage=80;epage=84;aulast=Sharma |
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